What is Depression?

Individuals with ADHD are three times more likely to suffer from depression than are people without the condition. This is a documented fact. Yet, accurate diagnoses are difficult to come by, and the risks associated with an incomplete or inaccurate diagnosis can be grave. Here is what you need to know about the symptoms, diagnosis, and treatment for depression.

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The majority of children and adults with ADHD report some kind of sleep challenge — from racing thoughts at bedtime to restless limbs at night to tortured wake-up rituals every morning. Typically, these sleep disturbances are due to an ADHDer's energy-inducing cocktail of hyperactivity, lack of focus, and, in some cases, stimulant medications. But insomnia doesn’t always mean ADHD, and other sleep disorders can mimic ADHD symptoms during daylight hours. Sleep apnea is a common culprit that's often misdiagnosed as ADHD — and vice versa. Fortunately, researchers are devising simple tests to definitively diagnose and get kids the treatment they need.

Depression is a common and serious mood disorder that impacts roughly 14.8 million Americans, or 6.7 percent of all adults, a year and is the leading cause of disability worldwide. Women are 70 percent more likely to experience major depression than are men. Two-third of all reported suicides in the U.S. are blamed on depression each year, and depression accounts for nearly $12 billion in lost workdays each year in America. Most people with depression experience improved symptoms with medication, psychotherapy, and lifestyle changes, however only about one-third of them ever seek treatment.

Why do so few people seek the treatment that so clearly improves symptoms of depression? The answer lays partially in the symptoms themselves, which can be difficult to differentiate from anxiety, ADHD, bipolar disorder, or a passing case of the blues. Depression, which often takes hold around age 18, is marked by feelings of sadness that last most of the day, stretch into weeks, and interfere with daily life. It causes the sufferer and close friends or loved ones significant pain. That, in turn, may lead to shame, embarrassment, and low self-esteem — all of which keep people suffering with depression from seeking medical help.

Symptoms of Depression

Symptoms of major depression include the following:

Loss of interest in activities that once brought joy

Change in appetite

Difficulty sleeping, or sleeping more than usual

Fatigue or lack of energy

Agitation or irritability

Feelings of worthlessness, hopelessness, guilt, or inadequacy

Difficulty concentrating or making decisions

Recurrent thoughts of death or suicide

Unexplained aches and pains

Types of Depression

Several distinct types of depression exist. They include the following:

Major depression, or clinical depression, is a serious brain disorder that’s symptoms interfere with all aspects of life, such as sleep, work, school, and eating. People with major depression experience deep sadness, hopelessness, despair, and loss of interest in activities they once enjoyed. It can cause physical and emotional pain, and make sufferers feel like life is not worth living. It is possible to have one major depressive episode, but most sufferers have several throughout their life, each one marked by at least two weeks of fatigue, restlessness, feelings of worthlessness, and diminished interest in activities. It is highly genetic, twice as common in women, and affects about 6.7% of the U.S. population over the age of 18.

Persistent depressive disorder, sometimes called dysthymia, is a period of depressed mood that lasts for two years or longer. It is chronic, ongoing depression. People with dysthymia have trouble being happy on even the most joyous occasions and are often described as gloomy or constantly complaining. Other symptoms include a feeling of hopelessness, low energy, and poor concentration. This can co-occur with major depressive periods, but is characterized by periods of less severe symptoms.

Bipolar mood disorder is less common than major depression and persistent depressive disorder. It is identified by drastic mood shifts over time — from extreme highs (mania) to extreme lows (depression) — as well as abrupt changes in energy levels, and distorted decision-making. It most commonly develops in late adolescence or early adulthood, is highly genetic, and affects approximately 2.6 percent of Americans.

In addition, these three types of depression can occur in relation to life circumstances: psychotic depression, postpartum depression, and seasonal affective disorder.

Psychotic depression is characterized by major depression alongside a form of psychosis such as hallucinations, delusions, or a break with reality. An episode of psychotic depression makes a person more likely to be diagnosed with bipolar mood disorder.

Postpartum depression occurs after the birth of a child in 10 to 15 percent of women, and is much more overwhelming and dangerous that the stereotypical “post-baby blues,” which includes mood swings or crying spells that fade very quickly. Postpartum depression is more long-lasting, and can interfere with a mother’s ability to care for her baby. It is characterized by feelings of inadequacy, insomnia, intense anger, or difficulty bonding with the baby.

Seasonal affective disorder is a type of depression that occurs when natural sunlight wanes. It commonly develops in young adulthood. Typically, this form of depression lifts during spring and summer. Its symptoms vary in severity. For some, it means mild feelings of irritability and being out of sorts. For others, symptoms can echo major depression and interfere with daily life. It can be treated with light therapy or the traditional psychotherapy and medication combination. Because it is associated with daylight, it is more common away from the equator.

Depression and ADHD

Depression overlaps with ADHD in two distinct ways: as a separate, unique condition occurring on its own, and as a secondary condition triggered by the frustrations of living with ADHD.

Primary Depression: Typically inherited, this type of depression is not triggered by an unpleasant circumstance or event. It appears gradually for no apparent reason, and symptoms are usually more severe and persistent than are those of secondary depression.

Secondary Depression: This occurs as a direct consequence of the chronic frustration and disappointment of living with a condition like ADHD, especially if it is left untreated. It often occurs in adults whose ADHD wasn’t recognized or treated when they were younger. They’ve struggled for years, thinking that they’re lazy, stupid, or not good enough to succeed socially or professionally. This leads to demoralization, which looks like depression. Doctors sometimes mistake the frustrations caused by ADHD for depression. Both conditions bring mood problems, forgetfulness, an inability to focus, and lack of motivation, which makes differentiation difficult for even specialists. To learn more about distinguishing them, see: Is It ADHD, Depression, or Both?, and ADHD and Depression: Diagnosing, Treating, and Managing a Dual Diagnosis.

Diagnosing Depression

The exact cause of depression is unknown. It appears to be a brain-based disorder caused by a combination of genetic, environmental, and psychological factors. Depressive symptoms are often linked to an imbalance in certain brain chemicals and to hormonal changes. Depression is more common in people who have relatives with the condition, though researchers have not pinpointed a specific gene responsible. Traumatic life events like the death of a loved one, or a history of childhood trauma, can trigger depressive bouts for some people.

You are more likely to develop depression if you also have certain medical conditions including ADHD, anxiety, and chronic pain. People with substance-abuse problems may be more likely to develop depression as well. The average age at first diagnosis is 32 years old, but 3.3 percent of teens aged 13 to 18 have experienced major depression.

The first step to getting a diagnosis is visiting a doctor. Your doctor may refer you to a mental health specialist for an evaluation. Depression brings mood problems, forgetfulness, and an inability to focus. Depressive moods are pervasive and chronic, and have no triggering event or cause. They can last for weeks or months, and there is nothing you can do to “snap yourself out of it.” Depressed people are lethargic and can’t initiate any activity due to lack of energy. They often fall asleep right away, but awake many times during the night with anxiety and negative thoughts.

Certain medications or other medical conditions can cause symptoms similar to depression. Part of obtaining an accurate diagnosis is working with your doctor to rule out these other possibilities through a physical examination, psychological interview, and lab tests.

There is no blood test that can quickly and easily diagnose depression. Lab tests might rule out other conditions your doctor suspects, like hypothyroidism. An exam can turn up physical signs of depression like lethargy or slow movements, poor concentration, lack of eye contact, or tearfulness. Your physician may ask if you have a family history of depression or other mental health disorders, and go through a full list of symptoms with you. Be sure to explain how long you’ve been experiencing symptoms, and if you have had bouts of depression previously. The next step is devising the right treatment plan with your physician.

Treatment Options for Depression

According to studies, 80 to 90 percent of people suffering from depression experience significant improvement with treatment, and almost all experience some control over symptoms. If you or a loved one is suffering from depression, there is hope.

Your primary care physician or psychiatrist may prescribe an antidepressant, which is an effective treatment for many people, but not a quick fix. Most patients taking an antidepressant see no benefit for the first two weeks; it typically takes 8 to 10 weeks to see the full benefit of this medication.

CBT is a short-term psychotherapy treatment that focuses on reversing negative thought patterns and on teaching positive coping mechanisms to patients, who work to control the connections between thoughts, feelings, and behaviors.

IPT for depression emphasizes the connections between symptoms and a patient’s interpersonal relationships. It is commonly recommended for children and adolescents with depression, but many adults use it to improve social functioning and personality issues.

In those rare cases where neither psychotherapy nor medication helps symptoms, electroconvulsive therapy (ECT) may be a good option.

People with mild depression report improved symptoms after making lifestyle adjustments like exercising regularly, meditating, and pursuing personally interesting hobbies.

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